OBSTETRIC AND GYNAECOLOGICAL DISEASES

Question 1

Definition of abortion

Definition of Period of viability

——— depends on the country

WHO definition of viability

——— is a differential diagnosis of bleeding 🩸 in early pregnancy

Answer 1

Abortion—
⎯ Termination of pregnancy before the period of viability

• Period of viability—the gestational age at which the foetus is capable of independent existence.
i.e., the GA at which if born it will have a reasonable chance of survival

• Period of viability-–depends on the country.

• WHO’s definition—foetal viability is possible after 20 weeks of foetal life (22 weeks of amenorrhea. i.e., 22 completed weeks from the date of the onset of the last menstrual period)

• Abortion It is a differential diagnosis of bleeding in early pregnancy

Question 2

Period of viability in Ghana— was defined as…….

Classification of abortion

Answer 2

Period of viability in Ghana— was defined as
⎯ From 28 completed weeks from the LMP, or ⎯ Birthweight greater than or equal to 1000g

Classification of abortion
A. Spontaneous (miscarriage)
B. Induced

1. Safe
2. Unsafe

i. Septic
ii. Non-septic

Question 3

Explain Unsafe abortion

WHOs definition of☝️

Answer 3

Unsafe abortion
⎯ A procedure for terminating an unwanted pregnancy either by persons lacking the necessary skills, or in an environment lacking the minimal medical standards, or both.

(WHO (1992))
⎯ A procedure for terminating an unwanted pregnancy either by persons lacking the necessary skills, or in an environment lacking the minimal medical standards, or both, and which causes, or is likely to cause acute or chronic ill-health or impaired reproductive function, or even death.

Question 4

COMPLICATIONS OF ABORTION

Answer 4

COMPLICATIONS OF ABORTION
1. Hemorrhage

2. Pelvic infection
3. Tubal infertility
4. Ectopic pregnancy from blockage and damage to tubes
5. Intrauterine synechiae as a result of infection or secondary to curettage (Asherman syndrome= intrauterine synechiae + amenorrhoea/oligomenorrhoea+ infertility)
6. Rh-alloimunisation if woman is Rh negative and baby is Rh positive. Require Anti-D immunoglobulin by deep IM within 72hrs of onset of bleeding)
7. Utrine perforation
8. Psychological problems
9. Maternal death

Question 5

Spontaneous abortion (miscarriage)
Risk factors

Causes of miscarriage
—It usually occurs…….
—first trimester causes
— second trimester causes
— both trimester causes

Answer 5

Spontaneous abortion (miscarriage)
Risk factors
• Reproductive history (increasing parity, hx of previous miscarriages, etc)
• Maternal age—frequency of clinical miscarriage increases with increasing maternal age
• Paternal age—rate of clinical miscarriage increases with increase in paternal age

Causes of miscarriages
• Clinically, miscarriage is categorised as early (first trimester) and late (second trimester)
• More than 80% of clinical miscarriage occur in first trimester, with majority of this occuring in the embryonic period (6-8 weeks)

Early trimester causes
1. Chromosomal
2. Smokingandalcohol-–theseareembryotoxins
3. Insufficientlypreparedendometrium
⎯ Luteal phase defect before conception
⎯ Oligomenorrhoea
⎯ hCG-dependent progesterone deficiency after conception

4.LHhypersecretionduringfollicularphase

5. Genetic(chromosomal)
6. Immunological(alloimune)factors
7. Hostileendometrium—endometriumcontainingahostileleukocyte population

Second trimester causes
i. Uterine anomalies [congenital and acquired such as bicornuate uterus, unicornuate uterus with rudimentary horn, severe septate uterus, submucous leiomyomata, intrauterine synechiae (adhesions), adenomyosis, etc]
ii. cervical incompetence
iii. Endocrine factors (hypothyroidism, presence of anti-thyroid antibodies, poorly controlled Diabetes Mellitus)
iv. Thrombophylias(coagulationproblems)

Both trimester causes
A. Idiopathic causes
B. Antiphospholipid syndrome
C. Febral (pyrexial) illnesses—e.g., malaria, typhoid D. Lower genital tract infections

Question 6

CLINICAL CATEGORIES OF MISCARRIAGE (CLINICAL FEATURES)

…………..is a sign of inevitable abortion

Blighted ovum……

Answer 6

Slides

Rupture of membranes with loss of amniotic fluid is a sign of inevitable abortion

• Blighted ovum (anembryonic gestation)—a gestational sac is present in the uterus but it is empty, even though it has reached a size at which it should contain a foetal pole.
No bleeding, or slight bleeding.
Pain is absent.

Question 7

Investigations

Treatment

Answer 7

INVESTIGATIONS
• B-hCG (urine and quantitative)
• USG (transabdominal, transvaginal) • Others, depending on the situation
4-Feb-2022 13

TREATMENT
• Resuscitation • Pain relief
• EOU
• Antibiotics
• Others depending on the situation

Question 8

Conclusion

Answer 8

CONCLUSION
• Abortion is one of the causes of bleeding in early pregnancy
• Abortion is the termination of pregnancy before the period of viability
• Period of viability in Ghana— defined as
⎯ From 28 completed weeks from the LMP, or ⎯ Birthweight greater than or equal to 1000g